Zizindikiro ndi mawonekedwe a khansa ya pancreatic

Ndikosavuta kuzindikira zizindikiro za oncology, ziribe kanthu kuti ndi chiwalo chiti chomwe chikukhudzidwa, nthawi zambiri zizindikirozi sizifotokozedwa. Makamaka pakakhala khansa ya kapamba, mawonetseredwe ake omwe m'magawo oyambilira samamvetseka konse. Ngakhale munthu atadzisamalira yekha, sizitanthauza kuti zonse zimamutsimikizira kuti sadzadwala.

Komabe, pali zinthu ngati kuzindikira khansa ya kapamba pogwiritsa ntchito chotupa, chomwe chimakupatsani mwayi wofufuza matendawa pamigawo yomwe moyo ndi thanzi la wodwalayo lingapulumutsidwe.

Pazinthu izi, ndizofunikira kwambiri - muyenera kungodzilimbitsa kuti mukhale ofufuza, malingaliro aliwonse omwe munthu amaganiza mwa munthu (asanakhale wodwala) amatuluka, osadikirira mawonekedwe ake kuti afotokozere matendawa.

Gland imagwira ntchito mthupi

Ichi ndi chiwalo chomwe chili ndi ziwiri m'malingaliro onse, chili ngati khadi yosewerera: dona wochokera kumwamba - dona wochokera pansi, ndani wofunikira kwambiri? Kodi ndizotheka kusankha yayikulu pazinthu ziwiri zomwe zimachitika mthupi? Kumbali imodzi, ndimapangidwe am'madzi opangira zakudya (pancreatic), kumbali inayo, ndikupanga katulutsidwe wamkati, komwe kumayang'anira kuchuluka kwa shuga m'magazi ndi zina zambiri.

Kuwongolera zaubwino komanso kuchuluka kwa magazi sikungopanga insulin.

Kuphatikiza pa ma cell a ꞵ omwe amachititsa kuti pakhale kupanga, palinso maselo a α omwe amapanga mahomoni okhala ndi dzina losiyana ndi kapangidwe kake.

Wotchedwa glucagon, umayeneranso kukhala ndi shuga wokwanira m'magazi - koma mulingo woyenera kwambiri pamavuto.

Pakachitika zoopsa, kupsinjika kwambiri (kosankhidwa ndi mawu oti "kugunda kapena kuthamanga"), glucagon imapereka nthawi yomweyo kuchuluka kwa shuga kofunikira kuti mukhale ndi ziwalo zofunika.

Zimayambitsa kukhudzidwa kwadzidzidzi kuchokera ku chiwindi cha m'matumbo a glycogen - chinthu chomwe chimasinthidwa mosavuta kukhala glucose, yemwe kudya kwake mu ubongo kuyenera kusasokonezedwa, komanso kwa mtima - kumupatsa zakudya panthawi yochuluka.

M'magawo okhala ndi njala nthawi yayitali kapena kudya mokwanira mwaufulu, glucagon imaperekanso chakudya chamafuta mosavuta.

Kukhalapo kwa maselo δ-masisumbu a Langerhans omwe amapanga timadzi tam'mimba yotchedwa Horatostatin imalola kuti thupi lilepheretse mphamvu iliyonse ya gland (kupanga mahomoni opanga kukula, omwe ali ndi kukula kwa thupi) ndi chithokomiro cha chithokomiro, pomwe mukugwiritsa ntchito "mahormoni am'mimba" omwe amapanga, amawongolera chidwi.

Chifukwa chake, ziphuphu zimatsimikizira kuthekera kwa thupi m'njira ziwiri: pomwe mandimu a pancreatic amaphwanya msuzi wa chakudya, womwe umachokera m'mimba kulowa mu duodenum, mu mafuta, mafuta ndi mapuloteni, magazi omwe amayenda mthupi lake amakhala ndi ma mahomoni omwe amalamulira kuchuluka kwa kagayidwe ndi mphamvu m'thupi.

Ziwerengero zamilandu

Kukhala ndi kachidindo kake mu International Classization of Diseases - ICD code 10 - C25, khansa ya kapamba ili ndi ziwerengero zake.

Malinga ndi iye, chiopsezo chokhudzidwa ndi oncology chimachulukitsa atakwanitsa zaka 30 mpaka 50, ndikukhala wamkulu patatha zaka 70.

Zomwe zimakhudzidwa kwambiri:

• amuna
• okhala megacities;
• banja;
• osuta
• ogula mankhwala okhala ndi zakumwa zoledzeretsa.

Gulu lomaliza limaphatikizapo iwo omwe amamwa mowa, osati mu mawonekedwe a vodika, vinyo, mowa, komanso nyimbo zamtundu uliwonse ndi zomwe zili.

Chiwopsezo cha kufa ndichipamwamba kwa iwo omwe ali ndi matenda, zomwe zimabweretsa zovuta osati ndi m'mimba, komanso ndi mtima (mitsempha), kagayidwe, magazi ndi kuphatikizika kwa magazi - mwa odwala:

• cholelithiasis ndi urolithiasis;
• Kunenepa kwambiri
• matenda a shuga;
• matenda oopsa osiyanasiyana etiologies;
• ndi kukhathamira kwamphamvu kwam magazi (thrombophlebitis, mitsempha ya varicose, hemorrhoids).

Kumanzere pa malo 4 padziko lapansi pokhudzana ndi kufa kwa ma oncological onse a matendawa, matendawa amafanana ndi anthu otukuka, otukuka.

Zomwe zimayambitsa matendawa

Zomwe zimayambitsa khansa zimakhala mowa komanso kupsinjika.

Mu malo achiwiri ndi miyambo ya mabanja ya chakudya: pafupipafupi, satiety wambiri, wokhala ndi ma muffin, okoma komanso ovuta kuphatikiza malonda.

Lachitatu limakhala ndi zakudya komanso zakudya zatsopano zomwe zimapangitsa kuti thupi lizipezeka.

Kuphatikiza pa izi, kufunika kukukula:

• kusuta;
• kudya mwachangu;
• kugwiritsidwa ntchito kwachidziwikire kofalikira mwanjira zamagetsi ndi mitundu ina ya ma radiation;
• moyo wabwino komanso wodekha;
• kugwiritsa ntchito matekinoloje oyesedwa kwa nthawi yayitali pokonzanso masewera ndikusunganso mawonekedwe a masewera;
• maulendo ndi maulendo opita ku madera akutali ndi mtunda wokhala ndi moyo wosiyanasiyana.

Chifukwa chake, mawonekedwe a munthu wamakono wokhwima: masewera, opambana komanso kuthana ndi mavuto omwe akutuluka, osagwirizana ndi foni, "kumasuka" ndi kusuta, kumwa moyenera koma pafupipafupi zakumwa zoledzeretsa komanso maulendo akunja padziko lonse lapansi kungakhale kopusitsa - kumatsimikizira kuti palibe khansa, ayi.

Kanema kochokera kwa Dr. Malysheva:

Gulu la matenda

Poganizira mawonekedwe ndi ntchito za thupi, pali magawo a ma pancreatic oncology:

• ndi anatomical ndi mbiri yakale yazinthu zomwe zimakhudzidwa;
• mwa kutengera momwe matendawo akuwonekera.

Zosiyanasiyana

Kutengera ndi minofu iti yomwe yakhudzidwa, ikhoza kuyimiridwa ndi mitundu iyi:

• mucinous cystadenocarcinoma wochokera ku woipa glandular cyst;
• chimphona chachikulu cell adenocarcinoma ndi cystic dongosolo degeneration;
• khansa ya acinar;
• glandular-squamous, kuphatikiza komwe kunachokera ma cell onse a magene a gland, komanso kuchokera kuma dipatimenti yopanga ma enzymes;
• zochedwa kutuluka kuchokera kumapangidwe a duct;
• ductal adenocarcinoma, yomwe imakhudza maselo okhala ndi ma ducts;
• khansa yopanda ena, yomwe ndiyowopsa kwambiri.

Kuphatikizidwa kwa zigawo zothandizira za endocrine kumabweretsa zomwe zimachitika:

• glucagonomas (kutulutsa glucagon ochulukirapo);
• insulinomas (kutulutsa insulin yambiri;
• gastrinomas (yokhala ndi hyperproduction of gastrin - mahomoni omwe amalimbikitsa ntchito yam'mimba).

Mwa chitukuko

Chifukwa cha magawano a chiwalo kukhala malo olumikizana komanso othandiza, chotupa chimasiyanitsidwa:

• mitu;
• mchira;
• thupi.

Zizindikiro zake

Zimatengera mtundu, gawo lachitukuko cha matendawa - - kapena asanachitike ma metastases, kupezeka kapena kusapezeka kwa matenda amtundu wamakedzana (maziko omwe matendawa adayamba).

Khansa yam'mutu imatha kuchitika:

• kupweteka kwam'mimba - m'chigawo cha epigastric (epigastric) chofalikira kumanzere hypochondrium ndikupitilira kumbuyo;
• kuwoneka kumverera kwadzaza m'mimba, kulemera pamimba pambuyo podya chakudya chokhazikika kapena chaching'ono;
• ntchito yosakwanira yochitidwa ndi kufooka, kutopa kopanda pake, kugona;
• kuwonda popanda maziko;
• mawonekedwe a buluu kapena kapezi wa gawo la miyendo chifukwa cha kupangika kwa magazi m'mitsempha yake.

Usiku, kuchuluka kwa ululu kumawonjezeka, kumafooketsedwa ndi kukhazikitsidwa kwa udindo wina: kukhazikika thupi kutsogolo kapena kugwedeza miyendo m'mamaondo atagona kumbuyo.

Ndi kukula kwa matendawa chifukwa cha kuwonjezereka kwa chiwindi chapafupi, zizindikiro za kusowa kwa gawo ili ziwonekera:

• jaundice, kuyambira pang'ono kuwonongeka kwa sclera, koma pang'onopang'ono kufikira mtundu wobiriwira wonyezimira wa khungu lonse la wodwalayo;
• khungu lakuthwa "chiwindi" kuyabwa chifukwa cha kuyimitsidwa kwamchere wa pakhungu;
• Kusintha kwa mkodzo, kumaso kwake kwa mtundu wa mowa, munthawi yomweyo kusungunuka kwa ndowe.

Zopatsa thanzi mu oncology zimakhala ndi zake. Chifukwa chakulephera kwa chakudya kugonjetsedwa ndi madzi a pancreatic, kusintha kwa ndowe kumawonekera - kumakhala mafuta kunyezimira, kumadzaza ndi kununkhiza. Matenda am'mimba amasonyezedwa ndi nseru, kusanza, kugona, kusowa kudya, kupewera chakudya chamafuta komanso kusalolera kwamafuta.

Mlandu wa khansa ya mchira kapena thupi la kapamba wowonongeka m'magulu a zochitika za m'thupi lafotokozedwa:

• Zizindikiro za matenda a shuga a mellitus (kuchuluka kwakukulu ndikukoka pafupipafupi, kamwa yowuma, ludzu);
• Zizindikiro za glucagonoma, wowonetsedwa ndi kusintha kwamkhungu ndi pakamwa panu pakatikati (lilime "limasunthika" mpaka gloss, kupeza mtundu wofiyira kwambiri, mawonekedwe a khungu lomwe limasokonekera pakona pakamwa, kutsekeka kwa khungu limodzi ndi zizindikiro za chikanga kapena dermatitis - zotumphukira).

Chithunzi cha gastrinoma chikufotokozedwa:

• kupweteka kwa epigastric mutatha kudya;
• kumverera kwa "mmwamba", "kuyimitsidwa" m'mimba;
• pafupipafupi (kenako pafupipafupi) kutsekula m'mimba;
• mafuta, ndowe zosagwira kuchokera kuchimbudzi.

Kuphatikiza pazodziwika, zizindikilo zambiri zimawonekera mu mawonekedwe a zizindikiro zokhala ndi pancreatitis yayitali:

• kupweteka pamimba;
• kutaya kwa mafupa;
• nseru
• kusintha pakulakalaka kuchepa kapena kusakhalapo kwathunthu;
• kuchuluka kunenepa.

Nthawi zambiri, khansa yachitukukoyi imayendera limodzi ndikumverera kolemera mu hypochondrium yamanzere, komanso:

• kusamba kwa msambo ndi kuchepa kwenikweni kwa libido ya akazi (chiwongolero chakugonana);
• "mafunde", ofanana ndi kusintha kwa thupi;
• kukokana (popanda kutaya chikumbumtima) m'miyendo ndi minofu ya nkhope
• mawonetseredwe akhungu mu mawonekedwe amtundu wa mawanga ofiira, otengedwa chifukwa cha matupi awo, kuchiritsa pang'onopang'ono kwa mabala, mapangidwe a zilema zamtunduwu - zilonda pamiyendo ndi kumapazi.

Kanema pazomwe zimayambitsa ndikuchiza khansa ya pancreatic:

Magawo otukuka

Mu matendawa, magawo asanu amasiyanitsidwa - kuchokera pagawo 0 mpaka gawo IV.

0-siteji - gawo lomwe khansayo sidziwonekera mwanjira iliyonse, chifukwa kusintha maselo kwayamba ndipo izi zimangokhazikitsidwa pofufuza kwakanthawi (CT kapena ultrasound ya kapamba). Chiwalo chomwe chikugwiriridwa panthawiyi chimapereka chitsimikizo cha 99% kuti chibwererenso.

Gawo Ndili ndi magawo awiri: IA ndi IB.

Mu gawo la IA, kukula kwa chotupacho mkati mwa chiwalo sikupita 2 cm. Zimadziwonekera lokha ndi mseru komanso kutsekula m'mimba ndikulakwitsa mu chakudya, kenako pokhapokha pokhapokha pokhapokha patatseguka.

Gawo la IB ndi chotupa choposa masentimita awiri ndikupita mkati mwa gland. Zizindikiro zimatsimikizika ndi komwe khansa imayambira.

Ngati ili m'mutu ndiye kuti:

• kutsegula m'mimba
• nseru
• jaundice
• kupweteka kwakanthawi komanso kosasimbika mu hypochondrium yamanzere.

Kukula kwa matenda a m'matumbo mchira kapena thupi la chithokomiro kumawonetsedwa ndi zizindikiro za gastrinoma, insulinoma kapena glucagonoma.

Kugawika kwa gawo lachiwiri mu magawo A ndi B kukutanthauza mphamvu zakukula kwa njirayi: A - iyi ndi nthawi yomwe chotupa chimatuluka kunja kwa chithokomiro (mu ducts ndi duodenum), B - chiyambi cha kufesa ndi maselo a khansa a ma lymph node oyandikira. Kuchepetsa kwambiri thupi, kusanza kwambiri, kutsekula m'mimba, kupweteka kwapafupipafupi kapena kupweteka kwambiri kumtunda kwachitatu kwam'mimba kumawonjezeredwa ndi zizindikirazo.

Gawo lachitatu ndi nthawi yomwe kufalikira kwa timitsempha timadutsa m'mitsempha ya m'mimba: m'mimba, matumbo akulu, ziwiya zikuluzikulu, ndulu, ndi zamitsempha zamtengo wapatali zachigawo.

Gawo lomaliza la IV ndi gawo lomwe metastases imafikira chotupa mu ubongo, mazira, mafupa, ndi ziwalo zina zakutali kwambiri, osatchulapo mapapu ndi chiwindi.

Zizindikiro zatsambali zikuwonekera:

• kupweteka kosalekeza pamtunda wachitatu wam'mimba ndi zotupa;
• kumverera kwa kulemera chifukwa cha "kupendekera pansi" chiwindi cholakulitsidwa kwambiri ndi ndulu pakuima;
• kuwonjezeka kwa ululu pakufufuza ziwalo izi (motero kumanja ndi kumanzere kwa hypochondrium);
• Zizindikiro za ascites ndimadzimadzi am'mimba.

Maonekedwe a wodwalayo amadziwika ndi mawu akuti "kufooka khansa": pakhungu latsika nthawi yomweyo, m'mimba "zalephera", maso owala kwambiri ndikuwonetsa ziphuphu ndi mafupa ena amkono, kuwonjezeka kwakukulu pakubwera kwa mawonekedwe amitsempha, kubwereranso m'maganizo.

About metastasis a chiwindi amasonyezedwa ndi:

• kulumikizana kosalekeza kwa sclera ndi khungu;
• magazi m`kamwa ndi mucous nembanemba mkamwa;
• Kusintha kwa mkodzo ndi ndowe (woyamba - mtundu wa mowa, wachiwiri - dongo loyera);
• ascites;
• kununkhira kosalekeza kuchokera pakamwa pa wodwalayo.

Kukhalapo kwa: metastases yaubongo

• machitidwe osakwanira;
• mikhalidwe;
• kusokonezeka kwa mawu (kumakhala kosamveka) ndi mawu amphuno;
• asymmetries a nkhope;
• kufooketsa masomphenya, kununkhiza, kulawa;
• matenda a gait ndi mgwirizano;
• kusintha kwina kwa minyewa mamembala;
• kutayika kwa maluso antchito poyamba, kenako osatha kuchita zonse zosavuta pakudzisamalira.

Lung metastasis ndi:

• kupweteka kwa chifuwa chowuma "cholimba";
• hemoptysis;
• kukhalapo kwa kupuma movutikira ngakhale mutha kupumula kwathunthu.

Mafupa a mafupa amawonetsedwa ngati ululu waukulu m'mafupa okhudzidwa, omwe amakula ndi mawonekedwe ofatsa (omenya).

Kutsimikizika kwa matenda

Kukhazikika kozindikiritsa kowona kumathandizidwa ndi kugwiritsa ntchito njira zofufuzira komanso zothandizira ntchito.

Zoyambirira zikuphatikiza:

• Ultrasound yam'mimba;
• Pancreatic MRI;
• CT ya thupi;
• kubwezeretsa cholangiography ndi cholangiopancreatography (maphunziro a endoscopic);
• PET (positron emission tomography);
• diagnostic laparoscopy.

Laboratory diagnostic imakhala pakupanga kuchuluka kwa mahomoni m'magazi:

• insulin;
• glucagon;
• gastrin.

Zambiri mu:

• magazi - zamchere phosphatase;
• magazi ndi mkodzo - pancreatic amylase;
• kale - pancreatic elastase.

Ndikofunikira kuvomereza zomwe zikuwonetsa kuyesedwa kwa magazi ambiri, kusanthula kwamkodzo, zitsanzo za chiwindi ndi coagulogram, zikwangwani zapadera za chikhodzodzo (chikhomo CA 19-9 chikugwirizana ndi pancreatic oncology), minofu biopsy.

Chithandizo chamankhwala

Kukhalira kwa chotupa pa siteji 0 kumalola kuchulukitsa kopitilira muyeso wa kulowerera kwa gamma; mu gawo 1, zotsatira zake zimatengera kukula kwake ndi zochitika za khansa yomwe ilowa ziwalo zoyandikana, komanso kupezeka kwa metastases yoyambirira. Chithandizo cha milandu yotsogola kwambiri imafuna chithandizo chovuta kwambiri.

Opaleshoni ingachitike ndi:

• kutulutsa kwathunthu kwa chiwalo;
• gawo kapena mbali;
• kukhazikitsidwa kwa endentopic stent;
• opaleshoni ya m'mimba;
• pogwiritsa ntchito njira ya Whipple.

Ngati lingaliro loyamba silikufuna kufotokozedwa, ndiye kuti njira yachiwiri ndi yachitatu imayendera chotupacho limodzi ndi dipatimenti yomwe yakonzedwa, ndikutsata magawo akumanzere.

Opaleshoni ya Bypass (ngati khansa singathe kugwira ntchito) ndikuyimitsa kwam'mimba, komwe kumapangitsa kuti magazi asamayende bwino, pomwe amamva kununkhira - kupewa kufinya kwamkati mwa kuyika chubu cham'mimba mu lumen yake yomwe imalumikizana ndi matumbo ang'onoang'ono kapena kutulutsidwa ndikuchotseka thupi.

Njira ya Whipple ndi njira yochotsera mankhwalawa ndi chipika (pamodzi ndi mutu wa ndulu yomwe ili mkati mwake, gawo lakumalo la duodenum, m'mimba ndi ndulu), zovomerezeka pamagawo oyamba a matendawa.

Njira zopatsirana (zofatsa) zoperekera chithandizo cha wodwalayo zimaphatikizaponso gawo lina la chotupa chomwe chimayika zovuta pazomwe zimayendetsa mitsempha ndikulepheretsa ntchito ya ziwalo zoyandikana, kapena metastases yake.

Njira zothetsera mavuto:

• kutsekeka m'mimba kapena kutsekeka kwa ma ducts;
• kufooka kwa matumbo, m'mimba, khoma la kutulutsa palokha.

Chofunikira kwambiri ndikuwonetsedwa pang'onopang'ono ndi chidwi cha ma gamma kuwononga maselo amoyo otsala.

Mphamvu ya chemotherapeutic pa chotupa pambuyo pochita opaleshoni imakhudzanso kukakamiza kwa magawidwe ndikukula kwa maselo obwezeretsanso ndipo ikuchitika ndi njira ya monochemotherapy.

Njira yoyamba imaphatikizapo kugwiritsa ntchito mankhwala amodzi okha omwe amapereka mphamvu 15-30%, pomwe wachiwiri (wogwiritsa ntchito mankhwalawa pogwiritsa ntchito njira zingapo) ukufika 40%.

Zakudya za khansa yogwiritsira ntchito chemotherapy zimapereka kukana kwamitundu yonse ya mowa ndi zinthu zolemera, kuyambitsa lactic acid ndizofunikira. Mankhwala a antiemetic amagwiritsidwa ntchito kuti athetse kukakamira kusanza.

Ndikofunikira kutsatira malingaliro a psychotherapist kapena psychologist.

Chithandizo cha radioactive chimaphatikizapo mbali ziwiri. Kuphatikiza pa zakumwa zachikhalidwe cha gamma (m'mbuyomu, mkati mwake, komanso pambuyo pa opareshoni) kapena kukwiya kwakanthawi kogwiritsa ntchito kuzimiririka, kugwiritsa ntchito katemera kwayamba, kuphatikiza mankhwala ochepetsa magazi omwe amasankha madera owopsa.

Njira ina yolimbikitsira yochotsa zotupa za chiwalochi ndi mfundo yotenga mankhwala othandizira odwala (kuwonetsa kagayidwe ka maselo a khansa okha, osavulaza ena athanzi).

Ziwonetsero

Ponena za khansa ya kudera lina lililonse, ndilabwino kwambiri.

Chotupa chikasiya chiwalo, chiyembekezero chamoyo chazaka zisanu chingapezeke 20% ya odwala (mothandizidwa ndi mankhwalawa), osachitidwa opaleshoni, nthawi imeneyi ndiyosakwana miyezi 6.

Njira ya chemotherapy imakulitsa moyo ndi 6-9, padera pochita ma radiation (osachitidwa opaleshoni) - pofika miyezi 11-13.

Opaleshoni yoyendera imalola wodwalayo kukhala ndi moyo pafupifupi zaka ziwiri, koma nthawi yoposa zaka 5 imatheka kokha kwa 8% ya odwala omwe adachitidwa.

Pambuyo polojekiti yolowererapo, chiyembekezo cha moyo wa wodwalayo ndichokwanira chaka chimodzi.

Zomwe zimayambitsa kufa mu khansa ya mapangidwe awa ndi kuyambika kwa ziwalo zolephera: aimpso, kwa chiwindi, mtima.

Kupewa

Makolo ayenera kuchenjeza ana kuyambira ubwana, kufikira atayamba kudziwa za ndudu ndi zakumwa zaukali, ponena za kuthekera kwa khansa ya kapamba m'thupi.

Kumbukirani kuti kuyamwa kwa poyizoni panjira iliyonse: kupuma, jekeseni, kulowetsedwa ndi chakudya ndi madzi kungayambitse kulowa kwake m'magazi, komwe kumadutsa minofu ya zikondamoyo.

Njira ina yobweretsera kuchepa kwa minyewa ya m'magazi ndi njira zonse zobweretsera chikhalidwe cha ischemia (kufa ndi njala kwa mpweya pafupi ndi magazi). Zochitika zovutitsa (zonse zomwe zimapangidwa mwachangu komanso mwachangu monga masewera ndi masewera osangalatsa) zimayambitsa ischemia.

Muyenera kupewa kusakanikirana mosagwirizana ndi zinthu zomwe zimakonzedwa ndi mbale komanso anthu ena ogulitsa "zosowa".

Pomaliza, kukhazikika pamachitidwe osiyanasiyana okhala ndi nthawi yokwanira kupumula kwausiku ndi chinthu chofunikira kuti munthu akhale ndi moyo wautali muzochitika zosinthika kwambiri zamakono.

Tisaiwale za kupitilira kwa mayeso azachipatala pafupipafupi ndikukwaniritsa malangizo a mankhwala - apanga njira yopita kuumoyo mwachindunji komanso yosavuta momwe kungathekere.